Clinical Laboratory Stewardship Guidelines by the National Committee

Clinical Laboratory Stewardship Guidelines by the National Committee for Laboratory Stewardship Oct. 2017 1

NCLS Publication

Background 3 most significant causes of 13 Billion test performed patient harm • 70% Ordering the wrong test decisions based • Failing to retrieve a test 10 -30% result unnecessary • Misinterpreting a test result

Trends in Healthcare Radiology Utilization management Blood Utilization Laboratory Stewardship Pharmacy Utilization management Antimicrobial Stewardship

National Committee for Laboratory Stewardship Commissioned in 2016 10 members from 7 academic institutions Medical Directors, Clinical Chemists, Medical Technologists Recommendation that integrated healthcare systems, independent hospitals implement laboratory stewardship programs Summarize the core elements of a successful hospital-based laboratory Stewardship program Compliments existing guidelines from Clinical Laboratory Standards Institute and Choosing Wisely

Laboratory Stewardship – 4 Basic Elements

Laboratory Stewardship – 4 Basic Elements Governance Leadership commitment Accountability to a high level medical executive Committee/subcommittees Laboratory expertise and other key support Networking

Laboratory Stewardship – 4 Basic Elements Interventions

Laboratory Stewardship – 4 Basic Elements Data Extraction and Monitoring a) Appropriateness of laboratory test orders. b) Retrieval of test results. c) Appropriateness of test interpretation. d) Impact of each stewardship intervention

Laboratory Stewardship – 4 Basic Elements Data review and strategies/tactics for improvement “An effective laboratory stewardship program will need to establish how the leadership committee will solicit and vet opportunities” “the committee may want to consider opportunities identified through the Choosing Wisely programs and other published research, or from internal data related to patient safety incidents”.

National Committee for Laboratory Stewardship Conclusion Evidence-based, patient-centered efforts to improve test utilization are justified, beyond being cost-effective, because they increase patient safety and Satisfaction NCLS has defined the core elements of a successful hospital-based laboratory Stewardship program NCLS future direction • devise a tiered recognition program and provide certificates of recognition, depending on the degree of participation

Clinical Laboratory Stewardship Guidelines by the National Committee for Laboratory Stewardship